Entry 21

I'm just going to start calling the titles by entry numbers since I've run out of creative ways to say "same shit, different day."

Not such a bad day at the hospital. Right now I have a few shifts at the private hospital a few blocks up the road from the other one we rotate at. It's four blocks away but a world apart. This private hospital is very much populated by Upper East Side types. I'm not kidding -- when I ask a patient about their prior surgical histories, more often than not they lie right to my face and say, "none" when I can see their eyebrows stretched up to their temples while the rest of their face looks windswept and micro-dermabrasioned down to reddened dermis. Sometimes they're honest with me about the plastic surgery (how many 74 year olds look like they're 40, after all?), but the forgotten-about turkey neck always gives it away. Gobble gobble.

Anyways, the patients here are very different than the ones at the other hospital. These tend to be wealthy, have a SLEW of private doctors ("My primary care doc is doctor x, my cardiologist is doctor y, my ENT is doctor z, my rheumatologist is doctor a, and my dermatologist is doctor b."). The good part about that is that when they end up in the ED, it's usually for something rather acute and serious that their primary couldn't handle.

The bad part is that they're also very high maintenance and almost all of them have M.E.S. -- what we call "Malignant Entitlement Syndrome." For some reason, many -- not all -- think they're the ONLY patient in the ER and deserve your undivided attention at all times. I try to defuse this from the get-go by initially telling them that they will likely have at least a 4-6 hour stay in total, so it's best just to grab the New York Times (or anything not produced by Rupert Murdoch) and sit back and wait.

I actually had a patient write me up to my supervisor for the following exchange (which I still don't regret and don't apologize for because I was honest and nice and made no bones about it):

Patient: Doctor, I've been here for two hours and haven't had my x-ray yet.

Me: Well, like we discussed, I didn't think you needed one for your knee because there's no clinical indication for it -- you say it hurts, and I believe that, but you didn't fall on it, twist it, injure it, and it's not swollen or tender to the touch. Xrays are good for visualizing bony problems, and I just don't think there's one there. I only ordered one because you repeatedly asked for it despite my judgment and explanation as to why you don't need it.

Patient: Well I think it's outrageous that I have to wait two hours for an xray.

Me: I do too, but xrays are triaged according to severity, so someone who has an actual suspected fracture, even if they come in after you, will have to go ahead of you. I'm sure you know this isn't a first-come-first-serve model.

Patient: I'm aware of that, but you know, my husband -- who is a big CEO -- is waiting for me.

[The name drop had to come sooner or later.]

Me: Your husband isn't the patient.

Patient: Yes but I have to get going.

Me: In here, everyone is equal, CEO or non-CEO. And like I said, I'm happy to discharge you without an xray. I know that you also have a private orthopedist, so I'd be happy to have you see him during a scheduled appointment that will probably be more amenable to your schedule.

Patient: LOOK. I JUST WANT THIS XRAY.

Me: Alright, time to level with you -- look around you and think about where you are -- you are in the middle of the biggest city in North America, in one of the busiest ERs in the entire country and probably in the Western Hemisphere. You're just going to have to wait until the five people who are here with KNOWN fractures receive THEIR xrays. If you don't want to wait, this is not a prison, and you are free to go. I am quite frankly asking you to think about those five other people right now and not just yourself.

Patient: Fine, goodbye.

And off she left, walked out with zero abnormalities in her gait.

Just to check, I looked to see in our computer system if she received an xray (it's linked up to her private orthopedists' since he's affiliated with our hospital).

The official report:

"No fracture or dislocation. No swelling or effusion. No history of trauma. Normal knee xray."

I don't believe in coddling people who don't need to be coddled. I don't believe in engaging in someone's dramatics for the sake of drama. On the other hand, I know I could be less bitchy in certain situations. I guess that's why someone wrote a letter about me. JUST SO YOU KNOW, however, I DO receive nice letters too. :)